1.

What is the most frequent site of cerebrospinal fluid leakage leading to cerebrospinal fluid
rhinorrhea?

A. cribriform/ethmoid region for traumatic causes, sphenoid sinus for nontraumatic causes
B. frontal sinus for traumatic causes, cribriform/ethmoid region for nontraumatic causes
C. cribriform/ethmoid region for both traumatic and nontraumatic causes
D. middle ear for traumatic causes, cribriform/ethmoid region for nontraumatic causes
E. frontal sinus for traumatic causes, middle ear for nontraumatic causes

2. Which of the following would not explain the development of a delayed cerebrospinal fluid
leak?

A. delayed increase in intracranial pressure

B. lysis of a clot in areas of dehiscence
C. resolution of edema
D. neural degeneration of olfactory fibers
E. wound maturation

3. Which of the following statements regarding the hypoglossal nerve is false?

A. It emerges between the internal carotid artery and the internal jugular vein.
B. It is normally identified lateral to the origin of the occipital artery in a neck dissection.
C. It passes deep to the stylohyoid and posterior belly of the digastric muscles.
D. It innervates the extrinsic muscles of the tongue.
E. It innervates all the intrinsic muscles of the tongue.

4. What are the most common nodes of involvement of the cervical lymphatic chain in head and
neck malignancy?

A. subdigastric or superior jugular

B. middle jugular
C. inferior jugular
D. spinal accessory
E. submandibular

5. Which of the following statements regarding neck dissection is false?

A. The hypoglossal and vagus nerves, the carotid arteries, and the internal jugular vein pass
deep to the digastric–stylohyoid muscles.
B. The internal carotid artery, the jugular vein, and the spinal accessory nerve lie anterior to
the transverse process of the first cervical vertebra.
 C. The facial nerve exits from the stylomastoid foramen above the posterior belly of the
digastric muscle and below the tip of the mastoid process.
D. The marginal mandibular branch of the facial nerve lies deep to the platysma and
anterior facial vein.
E. The lingual and hypoglossal nerves and the submandibular duct lie in the loose
connective tissue superior to the myohyoid muscle.

6. What injured area is the most commonly missed when evaluating a penetrating neck injury
during endoscopy?

A. esophageal inlet
B. distal cervical esophagus
C. Nasopharynx
D. Vallecula
E. supraglottic area

7. Which of the following statements regarding thyrogloblulin in the follow-up of thyroid cancer
is true?

A. It is helpful only after total thyroid ablation.

B. Readings are adjusted to the amount of antithyroglobulin antibodies present in serum.
C. Undetectable thyroglobulin levels exclude tumor recurrence.
D. Thyroglobulin levels are affected by estrogen administration.
E. Levels should be measured until tests are negative for 3 years.

8. Which of the following statements regarding radioactive iodine therapy of thyroid cancer is
true?

A. It necessitates hospitalization if the dose is 20 mCi or higher.

B. It should be done after normalizing thyroid-stimulating hormone levels.
C. It is performed following 2 days of a low-iodine diet.
D. It is repeated until the tumor no longer concentrates radioactive iodine.
E. L-thyroxine is used to control subsequent hypothyroidism.

9. A patient has facial symmetry at rest but obvious right facial weakness when she smiles. She
is just able to close her right eye, and there is definite but minimal movement of the right
forehead. Under the House-Brackmann system, she would be described as grade

A. I.
B. II.
C. III.
D. IV.
E. V.
10. Needle electromyography can be helpful in all of the following facial nerve management
situations except
A. selection of patients for decompression surgery.
B. prognosis for spontaneous recovery of paralysis lasting 3 to 6 months.
C. intraoperative monitoring.
D. prognosis for spontaneous recovery of paralysis lasting 2 to 3 weeks.
E. postoperative monitoring.

11. Histopathologic studies of the temporal bones of patients who have died after having Bell's
palsy are most consistent with

A. demyelination that occurs maximally in the middle ear and mastoid segments.
B. demyelination that occurs maximally in the labyrinthine segment and at the meatal
foramen.
C. changes diagnostic of a viral infection.
D. inflammatory changes primarily involving the labyrinthine segment and the meatal
foramen.
E. inflammatory changes primarily involving the internal auditory canal segment.

12. The target region for the auditory brain stem implant is the

A. interstitial nucleus of Cajal.

B. dorsal and ventral cochlear nuclei.
C. zona inserta of the cochlear nerve.
D. roof of the fourth ventricle.
E. superior and medial vestibular nuclei.

13. Facial nerve stimulation during cochlear implant use is most likely to occur in patients with
deafness from

A. large vestibular aqueduct syndrome.

B. aminoglycoside ototoxicity.
C. temporal bone fracture.
D. congenital cytomegalovirus infection.
E. autoimmune inner-ear disease.
14. Which of the following is not characteristic of salicylate ototoxicity?

A. preservation of otoacoustic emissions

B. reversibility
C. dose dependence
D. potential to decrease caloric response
E. potential to cause moderate to severe hearing loss

15. Which of the following statements represents a characteristic of the loudness of tinnitus?

A. Loudness matching with pure tones shows a close relationship to subjective tinnitus
loudness.
B. Loud tinnitus only occurs at pitch-matched frequencies with hearing loss greater than 30
dB.
C. Loudness frequently fluctuates daily.
D. Parauditory tinnitus is perceived as louder than sensorineural tinnitus.
E. Distressingly loud tinnitus is more characteristic of middle-aged individuals than of the
elderly.

16. The facial recess provides access to the

A. internal auditory canal.

B. retrolabyrinthine air cells.
C. epitympanic space.
D. posterior mesotympanum.
E. mastoid antrum.

17. A culture of purulent otorrhea that is manifest on the second day after placement of
ventilating tubes is most likely to isolate which organism?

A. Proprionibacterium acnes
B. Bacteroides fragilis
C. Proteus vulgaris
D. Staphylococcus epidermidis
E. Pseudomonas aeruginosa

18. Which cranial nerve is most commonly involved with suppuration involving the petrous
apex?

A. V
B. VI
C. VII
D. VIII
E. XII
19. In cholesteatomas, most bone resorption occurs because of

A. pressure necrosis.
B. the action of osteoblasts.
C. the action of osteoclasts.
D. the action of mononuclear phagocytes.
E. alkaline phosphatase.

20. Which of the following is least effective in preventing the spread of infection from the
middle ear to cause a complication?

A. bone and periosteum

B. eustachian tube
C. respiratory epithelium
D. perforating veins and venules
E. tympanic membrane

21. The following is true of the Macewens triangle except

a. A triangle formed by the root of the zygomatic arch, the posterior wall of the bony
external acoustic meatus, and an imaginary line connecting the extremities of the first
two lines; used as a guide in mastoid operations.
b. It is a guideline for reaching the antrum
c. It is located on the mastoid segment of the temporal bone
d. The depth of the antrum from the surface of the triangle increases with growth of the
skull
e. Spine of Henle is a useful landmark

22. The following facts about facial nerve are true except:
a. After leaving the Pons the V11 nerve passes thru the CP angle
b. The horizontal segment lies between the chochleariform process and the pyramidal
eminence
c. At the geniculate ganglion the facial nerve runs vertically to form the mastoid
segment and exits thru the stylomastoid foramen
d. The chorda tympani nerve arises from the vertical mastoid segment of the V11 nerve
e. It is both motor and sensory

23. Where does the sphenoid sinus lie in relation to the most posterior ethmoid cell?
a. Inferior and medial
b. Inferior and lateral
c. Superior and medial
d. Superior and lateral
e. None of above
24. Where is the natural ostium of sphenoid sinus in relation to the superior turbinate?
a. Medial, and within millimeters of its inferior border
b. Medial, and within millimeters of its superior border
 c. lateral, and within millimeters of its superior border
d. lateral, and within millimeters of its inferior border
e. none of above
25. What is the normal angle of a line drawn from the nasal spine to the sphenoid ostium?
a. 45 degree
b. 30 degree
c. 60 degree
d. 70 degree
e. 15 degree
26. Which ossicular component develops of membranous bone?
a. Head and neck of malleus
b. Body and short process of incus
c. Long process of incus
d. Stapes
e. Anterior process of the malleus

27. What structure is located inferior to the subiculum and posteroinferior to the promontory?
a. Round window
b. Oval window
c. Prominence of the facial canal
d. Sinus tympani
e. None of above
28. Which planes are the oval and round windows oriented in?
a. Oval window is in the sagittal plane, round window is in the transverse plane
b. Oval window is in the transverse plane, round window is in the sagittal plane
c. Both are in the sagittal plane
d. Both are in the transverse plane
e. None of above
29. Where does most movement of stapes occur?
a. Anterior – inferior portion of the footplate
b. Posterior- inferior portion of footplate
c. Posterior – superior portion of footplate
d. Anterior – superior portion of footplate
e. None of above
30. How does a cholesteatoma appear on MRI?
a. Intermediate signal on T1 and high signal on T2 – weighted images
b. High signal on T1 and low signal on T2 – weighted images
c. Intermediate signal on T1 and low signal on T2 – weighted images
d. High signal on both T1 and T2 – weighted images
e. Low signal on both T1 and T2 – weighted images
31. What bacterium is associated with rhinophyma?
a. Aspergillus fumigates
b. Fusobacterium necrophorum
c. Demodex follicularis
d. Acne rosacea
e. Staphylococcus aurius
32. Which organism most commonly causes post- meningitic hearing loss?
a. haemophilus influenza
b. streptococcus pneumonia
c. neisseria meningitides
d. staphylococcus aureus
e. bacteroides fragilis
33. The most common layer of otic capsule involved in otosclerosis is?
a. Outer periosteal layer
b. Inner periosteal layer ( endosteum)
c. Middle endochondral layer
d. All the three layers
e. None of above
34. What is the most likely diagnosis of fistula 1 cm anterior to the tragus associated with a
cystic bulge in the anterior ear canal in an 8 month- old infant?
a. First branchial arch sinus type I
b. First branchial arch sinus type II
c. Second branchial arch sinus
d. Third branchial arch sinus
e. First branchial arch sinus type III